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目的:总结34例膀胱横纹肌肉瘤患儿行腹腔镜根治性全膀胱切除+乙状结肠原位膀胱术的护理措施及效果。方法:术前给予多学科协作制定治疗方案、做好家属心理护理、化疗药物副作用的观察和处理;术后给予循序渐进的营养支持、管道护理、个性化的伤口护理以及控尿、排尿功能训练指导。结果:34例患儿取得了良好的治疗效果,未发生出血、尿瘘、吻合口瘘等并发症;随访10个月有2例患儿达到完全尿控,其余患儿均日间尿控良好,有6例患儿夜间睡眠时较差,随着年龄的增加和手术后时间延长,尿控率逐渐提高。结论:膀胱横纹肌肉瘤患儿行腹腔镜根治性全膀胱切除+乙状结肠原位膀胱术,采用多学科协作,术前讨论确定化疗方案、手术方式,针对性对患儿家属实施心理指导;术后循序渐进的营养支持、个性化的伤口护理、尿控管理以及出院健康指导有助于手术获得成功,有效的减少了术后并发症的发生,使患者达到了满意的治疗效果。
Objective: To summarize the nursing measures and results of laparoscopic radical cystectomy + sigmoid colon in 34 cases of bladder rhabdomyosarcoma. Methods: The preoperative multidisciplinary cooperation in the development of treatment options to do family psychological care, side effects of chemotherapy drugs observed and treated; after graduation to give nutritional support, pipe care, personalized wound care and urinary control, urinary function training guidance . RESULTS: Thirty-four children achieved good therapeutic effect without any complications such as hemorrhage, urinary fistula and anastomotic fistula. During the follow-up period of 10 months, 2 children achieved complete urinary control, and the rest of children had good daytime urinary control. Six children with poor sleep at night, with increasing age and prolonged postoperative time, urine control rate gradually increased. Conclusions: Laparoscopic radical cystectomy + sigmoid colon in children with bladder rhabdomyosarcoma were performed with multidisciplinary cooperation and preoperative discussion to determine the chemotherapy regimen, surgical approach and targeted psychological intervention for the family members of children. The nutritional support, personalized wound care, urine management and discharge health guidance help to the success of surgery, effectively reducing the incidence of postoperative complications, so that patients achieve satisfactory treatment.